Menopause and the musculoskeletal system

Menopause involves a reduction in the hormone oestrogen. This is the reason women often get more aches and pains as they go through menopause. Oestrogen directly affects the structure and function of muscles, ligaments, tendons, joints and bones.

It’s important to understand these changes, as a lot can be done before, during and after menopause to minimise the adverse effects these changes have on our bodies and quality of life.

Menopause and its effect on our muscles

With the decline in oestrogen at menopause, women experience a rapid decrease in muscle mass and strength (sarcopenia) and are more prone to muscle injury. This affects all skeletal muscles within the body and might explain why a woman may start to develop more muscular injuries, or aches and pains, while participating in their regular activities as they approach menopause. Balance can also be affected due to loss of muscle mass.

Oestrogen also influences the level of cortisol (a stress hormone) production in the body. Reduced oestrogen levels actually increase cortisol levels, which can cause the muscles to become more tense and pain sensitive.

Menopause and its effect on our ligaments, tendons and joints.

Ligaments are the tissues that connect bone to bone around joints, while tendons connect muscle to bone. Reduced oestrogen causes reduced collagen content and so an increased stiffness in ligaments and tendons. Stiffer ligaments will make joints feel tighter. This increased stiffness can mean an increase in joint stability, but also reduced joint mobility. Stiffer tendons will not stretch as easily when pulled by the associated muscle, which can lead to increased muscle and tendon injury. 

Oestrogen also has anti-inflammatory effects and helps to keep joints healthy and lubricated.

Menopause and its effect on bone density

Women loose approximately 10% of their bone mass in the first 5 years after menopause. Oestrogen plays a crucial role in maintaining bone density, and as the levels of estrogen decrease during menopause, women become more susceptible to osteoporosis, a condition where bones become brittle and fragile. Osteoporosis can lead to an increased risk of fractures, particularly in the hip, spine, and wrist. The lifetime risk of an osteoporotic fracture is 50% for women and 20% for men, so it is very important to be aware of your bone density, and ultimately to prevent bone loss.

Minimising the effects of Menopause

Reduced muscle mass, pain sensitive tissues, reduced bone density, stiff tendons and ligaments – it may sound like a perfect catastrophe! However this doesn’t have to be the case. Understanding the changes happening in your body and implementing preventative measures, can make a big difference. Our joints do recalibrate and settle over time, so the discomforts we experience do not necessarily have to persist.

Exercise is very important – as it helps maintain bone density, muscle strength and balance (as well as having cardiovascular and mental health benefits!). A combination of progressive resistance training and moderate impact weightbearing exercise is recommended. Current WHO guidelines recommend that adults complete 150 minutes of moderate intensity exercise per week as well as 2-3 strength sessions. This equals about 30 minutes of exercise per day. Talk to your Osteopath about the best exercise program for you.

There are many other variables in our life that influence healthy bones, joints and muscles. Weight, stress levels, sleep quality, a balanced diet, smoking and alcohol all have a part to play.

References

1. Chidi- Ogbolu N & Baar K 2019, ‘Effect of Estrogen on musculoskeletal performance and injury risk’,  Frontier in physiology, vol. 9, article 1834.

2. Nedergaard A, Henriksen K, Karsdal MA & Christiansen C (2013), ‘Menopause, Estrogens and frailty’ Gynecological Endocrinology, vol. 29, no. 5, pp 418-423.

3. Woods NF,Mitchell ES & Smith- DiJulio K 2009, ‘Cortisol levels during the menopausal transition and early postmenopause: Observations from the Seattle Midlife Women’s Health Study’, Menopause, vol. 16, no. 4, pp. 708-718.

4. Rees JD, Maffuli, N & Cook, J 2017, ‘Management of tendinopathy’, The American Journal of Sports Medicine,vol. 37, no. 9, pp. 1855-1867.

5. Australasian Menopause Society 2020, www.menopause.org.au

6. Rizzoli R 2018, ‘Postmenopausal osteoporosis: Assessment and management’ Best Practice & Research Clinical Epidemiology